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pdf Non-visible Questions
Label
PDF
Name
(step)
Location
Response
Input Item
Visibility Trigger
Other
Date of Death
Injunction Below "Is this
(1)
person
deceased?"
Text Entry The field is displayed
if the user selects the
"Yes" radio
button for "Is this
person deceased?"
Organization
Description
Injunction Below
(1)
Organization
Type
Text Entry
The field is displayed
if the user selects an
organization type
that requires a
description.
Name of
Occupation
Injunction Beside Profession Text entry
(1)
or Field of
Licensure
The field is displayed
if the user selects a
profession or field of
licensure that
requires a
description.
“Specialty” is
displayed in place of
“Name of
Occupation” if the
selected profession
or field of
licensure requires
specialty
information.
Specialty
Injunction Beside Profession Drop List
(1)
or Field of
Licensure
The field is displayed
if the user selects a
profession or field of
licensure that
requires information
for specialty.
“Name of
Occupation” is
displayed in place of
“Specialty” if the
selected profession
or field of licensure
does not require
information for a
specialty.
FEIN (Federal
Employer
Identification
Number)
Injunction Below checkbox Text Entry
(1)
"Does the subject
have an FEIN, or
UPIN
identification
number?"
The field is displayed
in the individual
report form if the
user selects the
checkbox for "Does
the subject have an
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
FEIN and UPIN text
entry fields.
UPIN (Unique
Physician
Identification
Numbers)
Injunction Below FEIN text
(1)
entry
Text Entry
The field is displayed
in the individual
report form if the
user selects the
checkbox for "Does
the subject have an
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
FEIN and UPIN text
entry fields.
FDA (Federal
Food and Drug
Administration)
Injunction Below checkbox Text Entry
(1)
"Does the subject
have a FDA or
CLIA
identification
number?"
The field is displayed
in the organization
report form if the
user selects the
checkbox for "Does
the subject have a
FDA or CLIA
identification
number?"
Selecting the
checkbox displays
FDA and CLIA, and
text entry fields.
CLIA (Clinical
Laboratory
Improvement
Act)
Injunction Below text entry
(1)
FDA (Federal
Food and Drug
Administration)
The field is displayed
in the organization
report form if the
user selects the
checkbox for "Does
the subject have a
FDA or CLIA
identification
number?"
Selecting the
checkbox displays
FDA and CLIA, and
text entry fields.
Text Entry
Type of
Affiliation
Injunction Below "Is the
Drop List
(1)
practitioner
affiliated with a
health care
entity?" checkbox
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries.
Entity Name
Injunction Below Type of
(1)
Affiliation
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries.
Country
Injunction Below "Is the
Drop List
(1)
practitioner
affiliated with a
health care
entity?" checkbox
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. United
States is the default
selection. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
Address
Injunction Below Country
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
Address Line 2
Injunction Below Address
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
City
Injunction Below Address
(1)
Line 2
Text Entry
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
State
Injunction Below City
(1)
Drop List
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
ZIP
Injunction Below State
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
Description
Injunction Below “Act or
(2)
Omission”
Text Entry
Date of Appeal
Injunction Below "Is the
(2)
action on
appeal"
Text Entry The field is displayed
if the user selects the
"Yes?" radio button
for "Is the action on
appeal?"
The field is displayed
if the user selects an
act or omission that
requires a
description.
Years
Injunction Beside Sentence
Drop List
(2)
of Judgment drop
list
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
does not apply, then
Years, Months and
Days drop lists are
displayed.
Months
Injunction Beside Years
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
does not apply, then
Years, Months and
Days drop lists are
displayed.
Days
Injunction Beside Months
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
does not apply, then
Years, Months and
Days drop lists are
displayed.
Hours
Injunction Beside Months
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
applies, then an
Hours drop list is
displayed.
State Changes
Label
PDF Name
Item Type
Trigger
Public Burden
Statement
Injunction
Modal
When the user selects the Public Burden Statement
link the modal is displayed.
Select a
Profession or
Field of
Licensure
Injunction
Modal
When the user sets focus on the Profession or Field of
Licensure text entry, the modal to select a profession
is displayed and focus is set on the Search text
entry. The user can enter text in the Search text box
to find a specific profession or select a profession
from the list without searching. The modal is hidden
once the user selects a profession from the list. The
user's selection populates the Profession or Field of
Licensure text entry.
Name of
Occupation
Injunction
Text Entry
Text entry is disabled if the user does not select a
profession or field of licensure requiring a
description.
License
Number
Injunction
Text Entry
Text entry is disabled if the user selects the "No/ Not
sure" option for "Does the subject have a license for
the selected profession or field of licensure?" For
organization reports, the label is “Does the
organization have a license?”
Modal
When the user sets focus on the Act or Omission text
entry, the modal to select an act is displayed and
focus is set on the Search text entry. The user can
enter text in the Search text box to find a specific act
or select an act from the list without searching. The
modal is hidden once the user selects an act from the
list. The user's selection populates the Act or
Omission text entry.
Select an Act or Injunction
Omission
| File Type | application/pdf |
| File Modified | 2017-11-09 |
| File Created | 2017-09-25 |